Hillary Clinton is wrong when she says that Medicare for all is not achievable. In fact, if she and her husband had embraced the concept in 1993, we would be nearly there today.
Medicare was supposed to be a first step toward Medicare for all. After activists tried and failed to include universal health care in the Social Security Act of 1935, and after President Harry Truman tried during his presidency to achieve that goal, supporters decided that an incremental approach was most likely to bring ultimate success.
So activists decided to fight to cover seniors, as a first step. They achieved that goal with the enactment of Medicare in 1965. In 1972, Medicare was expanded to cover people with disabilities. But that is where progress stopped.
In 1993, the electorate wanted better health care. The newly elected President Bill Clinton put Hillary Clinton in charge of a task force to develop a proposal. They created a Rube Goldberg machine, easily attacked by the health care industry because the proposal was so hard to understand. If instead, the Clinton administration had further built on the extremely successful and popular Medicare program, then nearly three decades old, they would likely have been successful. There was a strong case to be made (as there still is) to lower the Medicare age of eligibility from age 65 to age 62, when seniors are first eligible for Social Security benefits.
Lowering the Medicare age to 62 or even 55 would have benefited Medicare, where the risk pool would be expanded to include younger, healthier seniors, as well as private health care insurance, where those same people – who, in private insurance, are the oldest and sickest — would have been shifted out. The Clintons could have also proposed to add to Medicare, a Medikids piece — universal coverage of all children. That was considered in 1965 by strategists seeking to take a first step toward government-provided health care, and continues, polls show, to be popular. The health care industry would, of course, have opposed the expansion. But an energized and united electorate, mobilized by a committed administration, could have overcome it. That is what happened in 1965, with the enactment of Medicare, when the medical industry tried as hard as it could to defeat it.
Those two expansions — lowering the Medicare age and adding children — would have been easy to explain and popular. They constitute excellent policy, and would have been easily understood by the electorate. A newly-elected Clinton administration, laser-focused on an incremental expansion of Medicare, would have had an excellent chance of success. President Obama could have built on that success, proposing lowering the Medicare age further, raising the Medikids age, and allowing those with pre-existing conditions and others to buy into Medicare at a reasonable price. Eventually, more and more people would have opted in, getting us ever closer to the goal of Medicare for All.
This strategy is still likely to work. It is completely compatible with Obamacare. Medicare is popular among conservatives and liberals alike. Many seniors, who have been a growing part of the Republican base, are hanging on until they reach their 65th birthdays. A Medicare expansion, polls show, is overwhelmingly popular, just as Social Security expansion is. As part of the expansion effort, a new push for a public option, in the form of a Medicare buy-in, would help reach the ultimate goal.
An incremental approach only works if one has a vision of where the incremental steps are leading. In a campaign, candidates present the ultimate goals, not a blueprint for incremental change. But to attack the ultimate goal as unrealistic, when incremental steps can get you there, is a disservice. It is a disservice to all of the millions of Americans who believe that high quality, affordable health care should be a right, not a privilege. It is a disservice to all those who want a more efficient health care system in order to have resources to spend on other pressing domestic needs. It is a disservice to those who see that a more efficient health care system will allow more compensation to be paid in the form of cash wages, as opposed to health insurance.
Claiming that such a noble, important and popular goal — Medicare for all — is unrealistic does not show pragmatism. Rather, it shows a lack of imagination.
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